Which antihypertensive agents are recommended for patients with diabetes?

NURSING questions

Case Presentation:L.N. is a 49-year-old white woman with a history of type 2 diabetes, obesity, hypertension, and migraine headaches. The patient was diagnosed with type 2 diabetes 9 years ago when she presented with mild polyuria and polydipsia. L.N. is 5’4″ and has always been on the large side, with her weight fluctuating between 165 and 185 lb. Initial treatment for her diabetes consisted of an oral sulfonylurea with the rapid addition of metformin. Her diabetes has been under fair control with a most recent hemoglobin A1c of 7.4%.Hypertension was diagnosed 5 years ago when blood pressure (BP) measured in the office was noted to be consistently elevated in the range of 160/90 mmHg on three occasions. L.N. was initially treated with Lisinopril, starting at 10 mg daily and increasing to 20 mg daily, yet her BP control has fluctuated. One year ago, microalbuminuria was detected on an annual urine screen, with 1,943 mg/dl of micro-albumin identified on a spot urine sample. L.N. comes into the office today for her usual follow-up visit for diabetes and HTN.Subjective data reveals that she is experiencing increased exertional SOB. She expresses concern because when this happens it takes her awhile to get her breath back to normal. Denies any pain or dizziness with these episodes.Physical examination reveals an obese woman with a BP of 154/86 mmHg and a pulse of 78 bpm. Otherwise exam is unremarkable.CC: “I am more short of breath when walking up stairs than I used to be”.

Questions NEED TO BE ABOUT 3-4 SENTENCES BUT THOROUGH ANSWERS

1. What are the effects of controlling BP in people with diabetes?

2. What is the target BP for patients with diabetes and hypertension?

3. Which antihypertensive agents are recommended for patients with diabetes?

4 What testing does this woman need ordered due to her change in status both SHORTNESS OF BREATH and BLOOD PRESSURE? (USE CASE STUDY ABOVE FOR THIS QUESTION)

5. What is the significance of microalbuminuria in this woman? How does this affect her cardiovascular risk?

Write this case study up as a clinical note including all elements of plan of care regarding issues presented in the case.

1.Describe the clinical manifestations, similarities, and differences of the following vitamin deficiencies: niacin, riboflavin (B2), thiamine (B1), folate, vitamin B12, vitamin B6,pantothenic acid (B5), biotin, vitamin C, vitamin K, vitamin E, vitamin A, and vitamin D.

Nursing discussions

Write 2 paragraphs for each prompt.

Use at least one scholarly source and evidence-based research in support of your ideas.

Nursing Advanced Pharmacology 

1.Discuss the development of new drugs in the United States as compared to other countries, and evaluate the pharmacoeconomic issues that lead to high prescription costs in the United States

2. Discuss the pharmacological aspects of Benzodiazepine . Give examples of how and when this drug is used.

Nursing Advanced Physiology and Pathophysiology 

 1.Describe the clinical manifestations, similarities, and differences of the following vitamin deficiencies: niacin, riboflavin (B2), thiamine (B1), folate, vitamin B12, vitamin B6,pantothenic acid (B5), biotin, vitamin C, vitamin K, vitamin E, vitamin A, and vitamin D.

2.Discuss the inherited mutation genes BRCA and BRCA 2, their prevalence, risks for different cancers, and recommended surveillance screenings for those with a confirmed genetically inherited mutation

Review the information in the Learning Resources. Using your knowledge of contemporary theories of chaos and complexity, consider how you could adapt Lewin’s classic model for change and apply this to your selected problem.

nursing leadership

To prepare:

  • Think about a problem in a specific unit or area of your organization or one with which you are familiar. What are the indications that there is a problem? What change may be needed? (Note: This problem should be different from the one you are addressing in the Week 2 Assignment.). A clinical problem works well; an example is that you note an increasing number of patients with deep vein thrombosis following orthopedic surgery.
  • Consider how you could locate evidence to examine the needed change. What literature would you review? Which professional organization standards or recommendations may be relevant? With whom would you communicate/network to ascertain community standards? Bear in mind that you may also look at evidence from fields other than nursing.
  • Review the information in the Learning Resources. Using your knowledge of contemporary theories of chaos and complexity, consider how you could adapt Lewin’s classic model for change and apply this to your selected problem.

By Day 3

Post a description of the problem, including relevant indicator(s). Provide a synopsis of how you would proceed in locating evidence, including research literature you would consult, which professional organization standards may be relevant, and with whom you would communicate or network to ascertain community standards. Then, identify how you would adapt Lewin’s classic model of change based on chaos and complexity theory to address this evidence-based change.

Practice Issue and Evidence Summary Guidelines

Nursing help

2017-03-06 00:21 Chamberlain College of NursingNR 451RN Capstone Course

Capstone Project Milestone 1:

Practice Issue and Evidence Summary Guidelines

Purpose

Clear identification of the practice issue is the first step in evidence-based nursing. Next, the evidence is reviewed to determine the best intervention to change practice outcomes. Completion of the milestone will include identification of the practice issue using the ACE Star model of Knowledge Transformation and a review of the evidence that will support an intervention that will change outcomes. The evidence summary will be conducted through the ‘breaking down’ of a systematic review on your topic for your change project.

Course Outcomes

This assignment enables the student to meet the following course outcomes: 

• CO4: Develops and outlines a scientific, systematic decision-making process to integrate critical thinking with clinical judgment to assure safe and effective outcomes. (PO #4)

• CO8: Selects evidence for best practice when planning professional nursing care for individuals, families, aggregates, and communities. (PO #8)

Due Dates

Milestone #1 consists of the completion of two worksheets (Practice Issue Worksheet) and (Evidence Summary Worksheet). Submit the completed worksheets to the Dropbox by Sunday, 11:59 p.m. MT at the end of Week 3.

Points 

Milestone #1 is worth 175 points (75 points for the Practice Issue and 100 points for the Evidence Summary).

Practice Issue Worksheet Directions

1. Practice Issue Worksheet: 

a. Read the guidelines including the grading rubrics below.  You will use this worksheet to document the practice issue presented and approved by your instructor in the Week 2 Discussions.  

i. Your practice issue will be the same for all three Milestone assignments in this course. 

b. Please type your answers directly into the worksheet.

Evidence Summary Worksheet Directions

2. Evidence Summary Worksheet: 

a. Read the guidelines including the grading rubrics below.  You will use this worksheet to incorporate your evidence summary into your Week 4 Milestone 2 assignment. 

b. Find a systematic review article in the Chamberlain library on your topic. Your Systematic Review Article must be peer-reviewed and include a narrative summary.

i. Go to the Chamberlain Library, click on RNBSN; NR451 Capstone course. You can find systematic reviews from many databases within the library, or by searching from the library homepage main search bar. 

ii. To search, combine the phrase ‘systematic review’ with your topic using the Boolean search operator AND. For example, if you are looking for a systematic review on fall prevention, you would use this Boolean search phrase: systematic review AND fall prevention. 

c. Type in your practice issue in the search tab; choose a systematic review article with a narrative summary to complete your worksheet.   

d. Please type your answers directly into the worksheet.

Grading Criteria: Practice issue

Category

Points

%

Description

Practice issue statement, scope of practice, practice area

20

27%

Identifies a Practice issue statement that is an independent nursing decision. 

Describes the scope of practice issues.

Example: The number of falls in your facility has been increasing, especially during shift change. What do you believe may be causing this? Are there any new interventions that could be put into place that would lessen or eliminatethe falls? This is where you begin your initial search into the problem or practice issue identified. 

Identifies the practice area.

Practice issue identification, rationale for selections

35

46%

Identifies how rationale behind how the practice issue was selected as a practice issue/problem

Documents the practice issue in a logical manner.

Types of evidence to gather, rationale for selections

20

27%

Identifies and documents types of evidence that must be gathered for review of the Practice Issue.

Describes rationale for each type of evidence that is selected.

Total

75 points

100%

Grading Rubric: Practice Issue

Assignment Criteria

A (100%)

Exceptional

Outstanding or highest level of performance

B (88%)

Exceeds

Very good or high level of performance

C (80%)

Meets

Competent or satisfactory level of performance

NI (38%)

Needs Improvement

Poor or failing level of performance

F (0%)

Developing

Unsatisfactory level of performance

Practice issue statement, scope of practice, practice area

20 points

Practice issue is identified. 

Practice issue is an independent nursing decision.

Scope of practice issue is fully described. 

Practice area identified. 

20 points ☐

Practice Issue is identified but is not clear.

Practice issue is an independent nursing decision. 

Scope of practice issue is described in simple terms. 

Practice area identified.

18 points ☐

Practice Issue is identified but is not clearly related to a nursing practice issue. 

Practice Issue isnot an independent nursing decision.

Scope of practice issue is described but is not logical in comparison to Practice Issue described.

Practice area identified. 

16 points ☐

Practice Issue is unclear.

Practice Issue is not an independent nursing decision.

Scope of practice issue is not described. 

Practice area identified. 

8 points ☐

Practice Issue isnot identified; practice issue is not an independent nursing decision; scope of practice issue is not described; practice area is not identified.

0 points ☐

Practice issue identification, rationale for selections

35 points

Documents how the practice issue was identified. 

Rationale for responses islogical anddescribed thoroughly. 

35 points ☐

Documents howthe practice issue was identified. 

Rationale for responses islogical and brieflydescribed.

33 points ☐

Documents howthe practice issue was identified. 

Rationale for responses issomewhat logical and vaguely described.

30 points ☐

Vaguely describes how the practice issue was identified. 

Rationale for responses issomewhat logical and vaguely described. 

15 points ☐

Does not document how the practice issue was identified. 

Rationale is not completed.

This section of the form is blank.

0 points ☐

Types of evidence to gather, rationalefor selections

20 points 

Identifies and documents what types of evidence is needed for review. 

Thoroughlydescribes rationale for all checked types of evidence selected.

20 points ☐

Identifies and documents what types of evidence is needed for review.

Briefly describesrationale for all checked types of evidence selected. 

18 points ☐

Identifies and documents what types of evidence is needed but includes only a minimum description for rationale for selected evidence. 

16 points ☐

Does not document more than one type of evidence that is needed for reviewand does not include rationale for selected type of evidence. 

8 points ☐

Does not document types of evidence orrationale. 

0 points ☐

Total Points Possible = 75 points

Grading Criteria: Evidence Summary

Category

Points

%

Description

Practice Problem 

10

10%

States practice problem in own words, with reference to the population, setting, and magnitude and in measurable terms.

Describes practice setting in measureable terms

Example: Consider the example given in the evidence summary above. The setting is the long term care facility where falls have been increasing and a trend has been identified that it seems to occur mainly during shift change. What do you believe may be causing this? What can be done to lessen or eliminate the falls? How does this number of falls relate to other months that have been tracked?

Source of evidence

20

20%

Identifies a source of evidence that is a nursing topic that is the subject of a systematic review article. 

Identifies search terms.

Provides a complete reference for the systematic review article.

Objectives of the article/Statement of questions

20

20%

Identifies the objectives of the article.

Identifies questions being addressed by author/s.

Explains relationship to your practice issue.

Interventions/Main findings summary

30

30%

Summarizes, in own words, suggested interventions by the author/s to improve patient outcomes.

Summarizes main findings of the author/s including strength of evidence for each main outcome.

Describes the relevance to the Milestone 2 paper.

Evidence-based solutions and limitations

20

20%

Outlines evidence-based solutions to consider for the capstone project.

Discusses any limitations to the studies included in the systematic review that you believe may impact use of the evidence provided in your project.

Total

100 points

100%

Grading Rubric: Evidence Summary

Assignment Criteria

A (100%)

Exceptional

Outstanding or highest level of performance

B (88%)

Exceeds

Very good or high level of performance

C (80%)

Meets

Competent or satisfactory level of performance

NI (38%)

Needs Improvement

Poor or failing level of performance

F (0%)

Developing

Unsatisfactory level of performance

Practice Problem

10 points

-Practice problem is in own words, with reference to the population of interest.

-Setting of the problem is identified

-Magnitude of problem is discussed.

-The practice issue is stated in measurable terms.

Met all objectives as stated above

10 points ☐

-Practice problem is in own words, with reference to the population of interest.

-Setting of the problem is not discussed.

-Magnitude of problem is discussed.

-The practice issue is stated in measurable terms. 

Met 3 out of 4objectives

9 points ☐

-Practice problem is in own words, with reference to the population of interest.

-Setting of the problem is not discussed.

-Magnitude of problem is not discussed.

-The practice issue is stated in measurable terms. 

Met 2 out of 4objectives

8 points ☐

-Practice problem is in own words, with reference to the population of interest.

-Setting of the problem is not discussed.

-Magnitude of problem is not discussed.

-The practice issue is stated but notmeasurable.

Met only 1 out of 4 objectives

4 points ☐

-Practice problem is not in own words

-There are no references to the population of interest.

-Setting and magnitude of problem is not discussed

-The practice issue is not stated in measurable terms. 

Did not meet anyobjectives

0 points ☐

Source of evidence

20 points

-Source of evidence is nursing topic.

-Source is aSystematic Review article. 

-Search terms are identified.

-Complete reference is given for Systematic Review article.

Met all 4objectives as above

20 points ☐

-Source of evidence is nursing topic.

-Source is a Systematic Review article. 

-Search terms are identified.

-Complete reference is not given for Systematic Review article.

Met 3 out of 4objectives

18 points ☐

-Source of evidence is nursing topic.

-Source is not aSystematic Review article. 

-Search terms are identified.

-Complete reference is not given for Systematic Review article.

Met only 2 out of 2 objectives

16 points ☐

-Source of evidence is not nursing topic.

-Source is a Systematic Review article. 

-Search terms arenot identified.

-Complete reference is not given for Systematic Review article.

Met only 1 out of 4 objectives

8 points ☐

-Source of evidence is not nursing topic or Systematic Review article.

-Search terms arenot identified.

-Reference is missing.

No objectives were met.

0 points ☐

Objectives of the article/ Statement of questions

20 points

-Objectives of article are identified.

-Questions being addressed by author/s are thorough. 

-Relationship to your practice issue is explained.

20 points ☐

-Objectives of article are identified.

-Questions being addressed by author/s are explained but not thorough. 

-Relationship to your practice issue is explained. 

18 points ☐

-Objectives of article are identified.

-Questions being addressed by author/s are not thorough. 

-Relationship to your practice issue is vague. 

16 points ☐

-Objectives of article are identified.

-Questions being addressed by author/s is missing. 

-Relationship to your practice issue is not explained. 

8 points ☐

-Objectives of article are not identified.

-Questions being addressed in article and relationship toown practice is not identified.

0 points ☐

Interventions/ Main findings summary 

30 points

-Thoroughly summarized (in their own words) the interventions the author(s) suggest to improve patient outcomes.

-Thoroughly summarized main findings of the author/s.

-Included strength of evidence for each main outcome.

30 points ☐

-Briefly summarized (in their own words) the interventions the author(s) suggest to improve patient outcomes.

-Briefly summarized main findings of the author/s.

-Included strength of evidence for each main outcome.

27 points ☐

-Vaguely summarized (in their own words) the interventions the author(s) suggest to improve patient outcomes.

-Vaguelysummarized main findings of the author/s.

-Included strength of evidence for most of main outcomes.

25 points ☐

-Summary of interventions is not in own words.

-Summarized main findings of the author/s is not apparent. 

-Did not include strength of evidence for any of the main outcome.

12 points ☐

-Summary of the interventions the author(s) suggest to improve patient outcomes is missing. 

-Summary of the main findings of the author is missing. 

-The strength of the evidence for outcomes are missing. 

0 points ☐

Evidence-based solutions and limitations 

20 points

-Outline of evidence-based solutions considered for project is documented and clear.

Discussed any limitations to the studies performed.

Documents limitationsbelieved may impact use in project.

20 points ☐

-Outline of evidence-based solutions beingconsidered for project is documented but not clear.

Discussed any limitations to the studies performed.

Documents limitations believed may impact use in project.

18 points ☐

-Outline of evidence-based solutions considered for project is documented but not clear.

Discussed most limitations to the studies performed.

Documents limitations believed may impact use in project.

16 points ☐

-Outline of evidence-based solutions being considered for project is not documented.

-Discussed mostlimitations to the studies performed.

Documents limitations believed may impact use in project.

8 points ☐

-Outline of evidence-based solutions, limitations of studies and potential impact to project is missing.

0 points ☐

Total Points Possible = 100 points

NR451 W3 Milestone1 Practice Issue & Evidence Summary Guidelines 2/16/17    GH

3

 This is the guidelines 

2017-03-06 00:23Chamberlain College of NursingNR451 RN Capstone Course

Capstone Project Milestone 1:

Practice Issue and Evidence Summary Worksheets

Student Name: Date:

Directions

1. Refer to the guidelines for specific details on how to complete this assignment.

2. Type your answers directly into the worksheets below.

3. Submit to the Dropbox by the end of Week 3, Sunday at 11:59 p.m. MT.

4. Post questions about this assignment to the Q & A Forum. You may also email questions to the instructor for a private response.

Practice Issue Worksheet

What is the Practice Issue?

Define the scope of the Practice Issue:

What is the practice area?

___ Clinical

___ Education

___ Administration

___ Other (list)_________________________________

How was the practice issue identified?(check all that apply)

___ Safety/risk management concerns

___ Unsatisfactory patient outcomes

___ Wide variations in practice

___ Significant financial concerns

___ Difference between hospital and community practice

___ Clinical practice issue is a concern

___ Procedure or process is a time waster

___ Clinical practice issue has no scientific base

__ Other:

Describe the rationale for your checked selections:

What evidence must be gathered? (check all that apply)

___ Literature search

___ Guidelines

___ Expert Opinion

___ Patient Preferences

___ Clinical Expertise

___ Financial Analysis

___ Standards (Regulatory, professional, community)

___ Other

Describe the rationale for your checked selections: 

Evidence Summary Worksheet 

Directions: Please type your answers directly into the worksheet.

Describe the practice problem in your own words with reference to the identified population, setting and magnitude of the problem in measurable terms:

Find a source of evidence that is a systematic review article on a nursing topic that is relevant to your practice problem. Write the complete APA reference for the systematic review article you selected:

Define the search terms for your systematic review:

Identify the objectives of the article.

Provide a statement of the questions being addressed in the work and how they relate to your practice issue:

Summarize (in your own words) the interventions the author(s) suggest to improve patient outcomes.

Summarize the main findings by the authors of your systematic review including the strength of evidence for each main outcome.  Consider the relevance to your project proposal for the Milestone 2 project paper.

Outline evidence-based solutions that you will consider for your project.

Discuss any limitations to the studies performed that you believe impacts your ability to utilize the research in your project.

NR451 W3 MS1 Practice Issue and Evidence Summary Worksheets  2/16/17    GH

3

Clinical question

“The thoughtful development of a well-structured EBP question is important because the question drives the strategies used to search for evidence”. (Dearholt & Dang, 2012, p.64). My question is: Will Congestive Heart Failure patients discharged from the hospital increase the chance of not being readmitted within 30 days with follow up care that includes post discharge telephone calls for support? 

P- (Patient, Population)-Congestive Heart Failure Patients

I-(Intervention)-Follow up phone call at 48 and 72 hours post discharge

C-(Comparison with current practice)-No follow up telephone calls for support.

Nursing help

2017-03-06 00:21 Chamberlain College of NursingNR 451RN Capstone Course

Capstone Project Milestone 1:

Practice Issue and Evidence Summary Guidelines

Purpose

Clear identification of the practice issue is the first step in evidence-based nursing. Next, the evidence is reviewed to determine the best intervention to change practice outcomes. Completion of the milestone will include identification of the practice issue using the ACE Star model of Knowledge Transformation and a review of the evidence that will support an intervention that will change outcomes. The evidence summary will be conducted through the ‘breaking down’ of a systematic review on your topic for your change project.

Course Outcomes

This assignment enables the student to meet the following course outcomes: 

• CO4: Develops and outlines a scientific, systematic decision-making process to integrate critical thinking with clinical judgment to assure safe and effective outcomes. (PO #4)

• CO8: Selects evidence for best practice when planning professional nursing care for individuals, families, aggregates, and communities. (PO #8)

Due Dates

Milestone #1 consists of the completion of two worksheets (Practice Issue Worksheet) and (Evidence Summary Worksheet). Submit the completed worksheets to the Dropbox by Sunday, 11:59 p.m. MT at the end of Week 3.

Points 

Milestone #1 is worth 175 points (75 points for the Practice Issue and 100 points for the Evidence Summary).

Practice Issue Worksheet Directions

1. Practice Issue Worksheet: 

a. Read the guidelines including the grading rubrics below.  You will use this worksheet to document the practice issue presented and approved by your instructor in the Week 2 Discussions.  

i. Your practice issue will be the same for all three Milestone assignments in this course. 

b. Please type your answers directly into the worksheet.

Evidence Summary Worksheet Directions

2. Evidence Summary Worksheet: 

a. Read the guidelines including the grading rubrics below.  You will use this worksheet to incorporate your evidence summary into your Week 4 Milestone 2 assignment. 

b. Find a systematic review article in the Chamberlain library on your topic. Your Systematic Review Article must be peer-reviewed and include a narrative summary.

i. Go to the Chamberlain Library, click on RNBSN; NR451 Capstone course. You can find systematic reviews from many databases within the library, or by searching from the library homepage main search bar. 

ii. To search, combine the phrase ‘systematic review’ with your topic using the Boolean search operator AND. For example, if you are looking for a systematic review on fall prevention, you would use this Boolean search phrase: systematic review AND fall prevention. 

c. Type in your practice issue in the search tab; choose a systematic review article with a narrative summary to complete your worksheet.   

d. Please type your answers directly into the worksheet.

Grading Criteria: Practice issue

Category

Points

%

Description

Practice issue statement, scope of practice, practice area

20

27%

Identifies a Practice issue statement that is an independent nursing decision. 

Describes the scope of practice issues.

Example: The number of falls in your facility has been increasing, especially during shift change. What do you believe may be causing this? Are there any new interventions that could be put into place that would lessen or eliminatethe falls? This is where you begin your initial search into the problem or practice issue identified. 

Identifies the practice area.

Practice issue identification, rationale for selections

35

46%

Identifies how rationale behind how the practice issue was selected as a practice issue/problem

Documents the practice issue in a logical manner.

Types of evidence to gather, rationale for selections

20

27%

Identifies and documents types of evidence that must be gathered for review of the Practice Issue.

Describes rationale for each type of evidence that is selected.

Total

75 points

100%

Grading Rubric: Practice Issue

Assignment Criteria

A (100%)

Exceptional

Outstanding or highest level of performance

B (88%)

Exceeds

Very good or high level of performance

C (80%)

Meets

Competent or satisfactory level of performance

NI (38%)

Needs Improvement

Poor or failing level of performance

F (0%)

Developing

Unsatisfactory level of performance

Practice issue statement, scope of practice, practice area

20 points

Practice issue is identified. 

Practice issue is an independent nursing decision.

Scope of practice issue is fully described. 

Practice area identified. 

20 points ☐

Practice Issue is identified but is not clear.

Practice issue is an independent nursing decision. 

Scope of practice issue is described in simple terms. 

Practice area identified.

18 points ☐

Practice Issue is identified but is not clearly related to a nursing practice issue. 

Practice Issue isnot an independent nursing decision.

Scope of practice issue is described but is not logical in comparison to Practice Issue described.

Practice area identified. 

16 points ☐

Practice Issue is unclear.

Practice Issue is not an independent nursing decision.

Scope of practice issue is not described. 

Practice area identified. 

8 points ☐

Practice Issue isnot identified; practice issue is not an independent nursing decision; scope of practice issue is not described; practice area is not identified.

0 points ☐

Practice issue identification, rationale for selections

35 points

Documents how the practice issue was identified. 

Rationale for responses islogical anddescribed thoroughly. 

35 points ☐

Documents howthe practice issue was identified. 

Rationale for responses islogical and brieflydescribed.

33 points ☐

Documents howthe practice issue was identified. 

Rationale for responses issomewhat logical and vaguely described.

30 points ☐

Vaguely describes how the practice issue was identified. 

Rationale for responses issomewhat logical and vaguely described. 

15 points ☐

Does not document how the practice issue was identified. 

Rationale is not completed.

This section of the form is blank.

0 points ☐

Types of evidence to gather, rationalefor selections

20 points 

Identifies and documents what types of evidence is needed for review. 

Thoroughlydescribes rationale for all checked types of evidence selected.

20 points ☐

Identifies and documents what types of evidence is needed for review.

Briefly describesrationale for all checked types of evidence selected. 

18 points ☐

Identifies and documents what types of evidence is needed but includes only a minimum description for rationale for selected evidence. 

16 points ☐

Does not document more than one type of evidence that is needed for reviewand does not include rationale for selected type of evidence. 

8 points ☐

Does not document types of evidence orrationale. 

0 points ☐

Total Points Possible = 75 points

Grading Criteria: Evidence Summary

Category

Points

%

Description

Practice Problem 

10

10%

States practice problem in own words, with reference to the population, setting, and magnitude and in measurable terms.

Describes practice setting in measureable terms

Example: Consider the example given in the evidence summary above. The setting is the long term care facility where falls have been increasing and a trend has been identified that it seems to occur mainly during shift change. What do you believe may be causing this? What can be done to lessen or eliminate the falls? How does this number of falls relate to other months that have been tracked?

Source of evidence

20

20%

Identifies a source of evidence that is a nursing topic that is the subject of a systematic review article. 

Identifies search terms.

Provides a complete reference for the systematic review article.

Objectives of the article/Statement of questions

20

20%

Identifies the objectives of the article.

Identifies questions being addressed by author/s.

Explains relationship to your practice issue.

Interventions/Main findings summary

30

30%

Summarizes, in own words, suggested interventions by the author/s to improve patient outcomes.

Summarizes main findings of the author/s including strength of evidence for each main outcome.

Describes the relevance to the Milestone 2 paper.

Evidence-based solutions and limitations

20

20%

Outlines evidence-based solutions to consider for the capstone project.

Discusses any limitations to the studies included in the systematic review that you believe may impact use of the evidence provided in your project.

Total

100 points

100%

Grading Rubric: Evidence Summary

Assignment Criteria

A (100%)

Exceptional

Outstanding or highest level of performance

B (88%)

Exceeds

Very good or high level of performance

C (80%)

Meets

Competent or satisfactory level of performance

NI (38%)

Needs Improvement

Poor or failing level of performance

F (0%)

Developing

Unsatisfactory level of performance

Practice Problem

10 points

-Practice problem is in own words, with reference to the population of interest.

-Setting of the problem is identified

-Magnitude of problem is discussed.

-The practice issue is stated in measurable terms.

Met all objectives as stated above

10 points ☐

-Practice problem is in own words, with reference to the population of interest.

-Setting of the problem is not discussed.

-Magnitude of problem is discussed.

-The practice issue is stated in measurable terms. 

Met 3 out of 4objectives

9 points ☐

-Practice problem is in own words, with reference to the population of interest.

-Setting of the problem is not discussed.

-Magnitude of problem is not discussed.

-The practice issue is stated in measurable terms. 

Met 2 out of 4objectives

8 points ☐

-Practice problem is in own words, with reference to the population of interest.

-Setting of the problem is not discussed.

-Magnitude of problem is not discussed.

-The practice issue is stated but notmeasurable.

Met only 1 out of 4 objectives

4 points ☐

-Practice problem is not in own words

-There are no references to the population of interest.

-Setting and magnitude of problem is not discussed

-The practice issue is not stated in measurable terms. 

Did not meet anyobjectives

0 points ☐

Source of evidence

20 points

-Source of evidence is nursing topic.

-Source is aSystematic Review article. 

-Search terms are identified.

-Complete reference is given for Systematic Review article.

Met all 4objectives as above

20 points ☐

-Source of evidence is nursing topic.

-Source is a Systematic Review article. 

-Search terms are identified.

-Complete reference is not given for Systematic Review article.

Met 3 out of 4objectives

18 points ☐

-Source of evidence is nursing topic.

-Source is not aSystematic Review article. 

-Search terms are identified.

-Complete reference is not given for Systematic Review article.

Met only 2 out of 2 objectives

16 points ☐

-Source of evidence is not nursing topic.

-Source is a Systematic Review article. 

-Search terms arenot identified.

-Complete reference is not given for Systematic Review article.

Met only 1 out of 4 objectives

8 points ☐

-Source of evidence is not nursing topic or Systematic Review article.

-Search terms arenot identified.

-Reference is missing.

No objectives were met.

0 points ☐

Objectives of the article/ Statement of questions

20 points

-Objectives of article are identified.

-Questions being addressed by author/s are thorough. 

-Relationship to your practice issue is explained.

20 points ☐

-Objectives of article are identified.

-Questions being addressed by author/s are explained but not thorough. 

-Relationship to your practice issue is explained. 

18 points ☐

-Objectives of article are identified.

-Questions being addressed by author/s are not thorough. 

-Relationship to your practice issue is vague. 

16 points ☐

-Objectives of article are identified.

-Questions being addressed by author/s is missing. 

-Relationship to your practice issue is not explained. 

8 points ☐

-Objectives of article are not identified.

-Questions being addressed in article and relationship toown practice is not identified.

0 points ☐

Interventions/ Main findings summary 

30 points

-Thoroughly summarized (in their own words) the interventions the author(s) suggest to improve patient outcomes.

-Thoroughly summarized main findings of the author/s.

-Included strength of evidence for each main outcome.

30 points ☐

-Briefly summarized (in their own words) the interventions the author(s) suggest to improve patient outcomes.

-Briefly summarized main findings of the author/s.

-Included strength of evidence for each main outcome.

27 points ☐

-Vaguely summarized (in their own words) the interventions the author(s) suggest to improve patient outcomes.

-Vaguelysummarized main findings of the author/s.

-Included strength of evidence for most of main outcomes.

25 points ☐

-Summary of interventions is not in own words.

-Summarized main findings of the author/s is not apparent. 

-Did not include strength of evidence for any of the main outcome.

12 points ☐

-Summary of the interventions the author(s) suggest to improve patient outcomes is missing. 

-Summary of the main findings of the author is missing. 

-The strength of the evidence for outcomes are missing. 

0 points ☐

Evidence-based solutions and limitations 

20 points

-Outline of evidence-based solutions considered for project is documented and clear.

Discussed any limitations to the studies performed.

Documents limitationsbelieved may impact use in project.

20 points ☐

-Outline of evidence-based solutions beingconsidered for project is documented but not clear.

Discussed any limitations to the studies performed.

Documents limitations believed may impact use in project.

18 points ☐

-Outline of evidence-based solutions considered for project is documented but not clear.

Discussed most limitations to the studies performed.

Documents limitations believed may impact use in project.

16 points ☐

-Outline of evidence-based solutions being considered for project is not documented.

-Discussed mostlimitations to the studies performed.

Documents limitations believed may impact use in project.

8 points ☐

-Outline of evidence-based solutions, limitations of studies and potential impact to project is missing.

0 points ☐

Total Points Possible = 100 points

NR451 W3 Milestone1 Practice Issue & Evidence Summary Guidelines 2/16/17    GH

3

 This is the guidelines 

2017-03-06 00:23Chamberlain College of NursingNR451 RN Capstone Course

Capstone Project Milestone 1:

Practice Issue and Evidence Summary Worksheets

Student Name: Date:

Directions

1. Refer to the guidelines for specific details on how to complete this assignment.

2. Type your answers directly into the worksheets below.

3. Submit to the Dropbox by the end of Week 3, Sunday at 11:59 p.m. MT.

4. Post questions about this assignment to the Q & A Forum. You may also email questions to the instructor for a private response.

Practice Issue Worksheet

What is the Practice Issue?

Define the scope of the Practice Issue:

What is the practice area?

___ Clinical

___ Education

___ Administration

___ Other (list)_________________________________

How was the practice issue identified?(check all that apply)

___ Safety/risk management concerns

___ Unsatisfactory patient outcomes

___ Wide variations in practice

___ Significant financial concerns

___ Difference between hospital and community practice

___ Clinical practice issue is a concern

___ Procedure or process is a time waster

___ Clinical practice issue has no scientific base

__ Other:

Describe the rationale for your checked selections:

What evidence must be gathered? (check all that apply)

___ Literature search

___ Guidelines

___ Expert Opinion

___ Patient Preferences

___ Clinical Expertise

___ Financial Analysis

___ Standards (Regulatory, professional, community)

___ Other

Describe the rationale for your checked selections: 

Evidence Summary Worksheet 

Directions: Please type your answers directly into the worksheet.

Describe the practice problem in your own words with reference to the identified population, setting and magnitude of the problem in measurable terms:

Find a source of evidence that is a systematic review article on a nursing topic that is relevant to your practice problem. Write the complete APA reference for the systematic review article you selected:

Define the search terms for your systematic review:

Identify the objectives of the article.

Provide a statement of the questions being addressed in the work and how they relate to your practice issue:

Summarize (in your own words) the interventions the author(s) suggest to improve patient outcomes.

Summarize the main findings by the authors of your systematic review including the strength of evidence for each main outcome.  Consider the relevance to your project proposal for the Milestone 2 project paper.

Outline evidence-based solutions that you will consider for your project.

Discuss any limitations to the studies performed that you believe impacts your ability to utilize the research in your project.

NR451 W3 MS1 Practice Issue and Evidence Summary Worksheets  2/16/17    GH

3

Clinical question

“The thoughtful development of a well-structured EBP question is important because the question drives the strategies used to search for evidence”. (Dearholt & Dang, 2012, p.64). My question is: Will Congestive Heart Failure patients discharged from the hospital increase the chance of not being readmitted within 30 days with follow up care that includes post discharge telephone calls for support? 

P- (Patient, Population)-Congestive Heart Failure Patients

I-(Intervention)-Follow up phone call at 48 and 72 hours post discharge

C-(Comparison with current practice)-No follow up telephone calls for support.

O-(Desired outcome)-Reduce the number of Readmissions

O-(Desired outcome)-Reduce the number of Readmissions

What are the common symptoms associated with an exacerbation of COPD?

nursing hw

Assessment of Respiratory Status (graded)

Please review the video on the assignments page under the discussion section as it will provide you with an opportunity to immerse yourself in the role of a nurse addressing tobacco use during routine patient care. In doing so, reflect on what you have learned about tobacco use and the role that nurses and other interdisciplinary team members play in helping to assist tobacco users with quitting. While viewing, it is also important to keep in mind that tobacco users move through stages of change in the process of quitting. They move from pre-contemplation to contemplation, contemplation to preparation; preparation to abstinence; abstinence to maintenance. Every stage requires a different strategy by a nurse.

After watching the video, and reflecting on the information presented, address each of the following questions.

  1. What are the common symptoms associated with an exacerbation of COPD?
  2. What assessment techniques will you use to assess Mary?
  3. Identify smoking strategies that would be appropriate for each of the encounters that Mary had with the nurse throughout the video that could have been used to assist Mary in quitting smoking.
  4. Find a resource in your community that could assist Mary. Start by searching the Internet for your local health department’s website. What services are available to Mary? Briefly describe the services that the state quit line provides. Does it meet the 4 As? Is it accessible, acceptable, affordable, or available for Mary?
  5. What will you do to follow-up on Mary’s smoking cessation process?

What measures and steps would you take to evaluate the success of the EHR implementation from a staff, setting, and patient perspective?

nursing homework

One way informatics can be especially valuable is in capturing data to inspire improvements and quality change in practice. The Agency for Healthcare Research and Quality (AHRQ) collects data related to adverse events and safety concerns. If you are working within a practice setting to implement a new electronic health record (EHR) system, this is just one of the many considerations your team would need to plan for during the rollout process.

In a paper of 1,250-1,500 words, address the following questions related to the advanced registered nurse’s role during this type of scenario:

  1. What key information would be needed in the database that would allow you to track opportunities for care improvement?
  2. What role does informatics play in the ability to capture this data?
  3. Which systems and staff members would need to be involved in the design and implementation process and team?
  4. What professional, ethical, and regulatory standards must be incorporated into the design and implementation of the system?
  5. How would the EHR team ensure that all order sets are part of the new record?
  6. How would you communicate the changes, including any kind of transition plan?
  7. What measures and steps would you take to evaluate the success of the EHR implementation from a staff, setting, and patient perspective?
  8. What leadership skills and theories would facilitate collaboration with the interprofessional team and provide evidence-based, patient-centered care?

You are required to cite five to 10 sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

What professional, ethical, and regulatory standards must be incorporated into the design and implementation of the system?

nursing homework

One way informatics can be especially valuable is in capturing data to inspire improvements and quality change in practice. The Agency for Healthcare Research and Quality (AHRQ) collects data related to adverse events and safety concerns. If you are working within a practice setting to implement a new electronic health record (EHR) system, this is just one of the many considerations your team would need to plan for during the rollout process.

In a paper of 1,250-1,500 words, address the following questions related to the advanced registered nurse’s role during this type of scenario:

  1. What key information would be needed in the database that would allow you to track opportunities for care improvement?
  2. What role does informatics play in the ability to capture this data?
  3. Which systems and staff members would need to be involved in the design and implementation process and team?
  4. What professional, ethical, and regulatory standards must be incorporated into the design and implementation of the system?
  5. How would the EHR team ensure that all order sets are part of the new record?
  6. How would you communicate the changes, including any kind of transition plan?
  7. What measures and steps would you take to evaluate the success of the EHR implementation from a staff, setting, and patient perspective?
  8. What leadership skills and theories would facilitate collaboration with the interprofessional team and provide evidence-based, patient-centered care?

You are required to cite five to 10 sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

Evaluate the sample (size, composition, or in the way the sample was selected in relation to the purpose of the study? Was the sample appropriate for the research or was it bias?

Nursing research

Library Assignment

Critique a Research Article

A critique is a method of displaying a logical and organized analysis of a written or oral piece. Critique can provide the readers with both positive and negative outcomes depending on the author. The purpose of this assignment is for the student to perform a critique on a research article that deals with today’s health issues. In this paper the student must be diligent at what the author are claiming, taking into account the research methods being utilized and look for pros and cons of the researcher’s outcomes.

The assignment must be a minimal of five pages, excluding title page and references. The assignment must be strictly following APA guidelines, points will be deducted if otherwise. Do not use first person throughout the paper until the section called evaluate the paper.  It will be divided in the following manner:

                Title page: Give the name of the article, the authors name(s) and your name. Following APPA

                Introduction:

·         Provide an overview of the author’s research problem, research questions and main point including how the author supports his or her point.

·         Explain what the author initial          objectives (hypothesis) and results including the process he or she used to arrive at such conclusion.

Evaluate the Research Methods: in paragraph form answer the following:

·         Does the author provide a literature review?

·         Is the research current and relevant to today existing health issues?

·         Describe the research type utilized?– experimental, non-experimental, quasi experimental, etc.

·         Evaluate the sample (size, composition, or in the way the sample was selected in relation to the purpose of the study? Was the sample appropriate for the research or was it bias?

·          How practicaldoes this work seem to you? How does the author suggest research results could be applied and how do youbelieve they could be applied?

·          Could the study have been improved in your opinion? If so provide how you think it could have improved.

·          Is the writing in the article clear straightforward?

·          Can further research be conducted on this subject? Explain

Conclusion: In your conclusion, try to synthesize the pieces of your critique to emphasize your own main points about the author’s work, relating the researcher’s work to your own knowledge or to topics being discussed in your course.

Reference Page: APA style, see rubric below

Healthcare policy (e.g. application to local, state, national, or global healthcare concerns, etc.)

nursing theory

Importance of Theory: Guidelines with Scoring Rubric

Purpose

The purpose of this assignment is to a) identify a nursing theory, b) analyze the importance of the selected theory to the nursing profession, c) summarize key concepts and relationships among the concepts of the selected nursing theory, d) present views of the selected theory on areas of specialization, and e) communicate ideas in a clear, succinct, and scholarly manner.

Course Outcomes

Through this assignment, the student will demonstrate the ability to:

  • (CO#1) Analyze theories from nursing and relevant fields with respect to their components, relationships among the components, logic of the propositions, comprehensiveness, and utility to advanced nursing. (PO1)
  • (CO#3) Communicate the analysis of and proposed strategies for the use of a theory in nursing practice. (PO3, 7, 10)
  • (CO#4) Demonstrate logical and creative thinking in the analysis and application of a theory to nursing practice. (PO4, 7)

Requirements

Description of the Assignment

This assignment focuses on the importance of nursing theory within the profession.  Selecting one nursing theory (non-nursing theories are not allowed), the nursing theory will be presented by identifying the key concepts present within the theory.  The selected nursing theory will then be applied to ONE of the following professional nursing practice areas:

  • Education (e.g. undergraduate, staff development, etc.)
  • Leadership (e.g. nurse executive, manager, leader, etc.)
  • Informatics (e.g. data management, etc.)
  • Healthcare policy (e.g. application to local, state, national, or global healthcare concerns, etc.)
  • Nurse practitioner

Criteria for Content

1.     Introduction: 

The introduction requires the following information.

  • Statements about nursing theory in general
  • Identification of the ONE nursing theory (non-nursing theories are not allowed) selected by the student to be used within this assignment. The specific selected nursing theory may be from any of the three categories of nursing theory (i.e. grand, middle-range, or practice), but must be a specific nursing theory (i.e. Orem, Roy, Benner, etc.); a category may not be used. 
  • Identification of the sections of the paper. 
  • References from nursing literature are required.

2.     Importance of Nursing Theory:

This section requires the following information.

·       Present an analysis of the importance of nursing theory, in general, to the nursing profession. Each of the following questions are to be answered.

  • Why should the study of nursing theory be included in a master’s program?
  • How is nursing theory useful to the nursing profession?
  • How can nursing theory be used to separate the nursing profession from other healthcare professions?
  • What would be ONE concern regarding the use of nursing theory within the profession?

·       References from nursing literature are required.

3.     Summary of Selected Nursing Theory:

This section requires the following information.

  • Present the name and author of the selected nursing theory (bibliographic and historical information about the theory or theorist is NOT included).  Identify when the nursing theory was initially published and the latest edition of the selected nursing theory.
  • Provide a summary of the key concepts contained within the selected nursing theory.
  • Provide a detailed description of how this nursing theory addresses each of the metaparadigms/ concepts (person, health, environment, and nursing profession) associated with nursing.  
  • Identify why this nursing theory selected and its potential use within the student’s selected Master’s track (i.e.  education, leadership, informatics, healthcare policy, or nurse practitioner)
  • References from nursing literature are required.

4.     Application of Specific Nursing Theory to Selected Professional Nursing Practice area:

This section includes the following elements:

  • Present a discussion of how the selected nursing theory defines and explains one of the following professional nursing practice areas:
  • Education (e.g. undergraduate, staff development, etc.)
  • Leadership (e.g. nurse executive, manager, leader, etc.)
  • Informatics (e.g. data management, etc.)
  • Healthcare policy (e.g. application to local, state, national, or global healthcare concerns, etc.)
  • Nurse practitioner
  • Present 2 (two) examples illustrating the above information.  Professional examples come from a student’s own practice experiences or from the scholarly literature. If the example is from the student’s experience, identify this as the source by using the first person in describing the example.
  • Keep each example succinct (about 1 – 3 paragraphs).
  • References from nursing literature are required.

5.     Conclusion:

This section includes the following elements:

  • Summarizes presented information regarding theory in general and its use within the nursing profession
  • Summarizes the selected nursing theory. 
  • Presents self-reflection regarding what was learned from writing this assignment. 

Criteria for Format and Special Instructions

1.              A nursing theory was used.

2.              This assignment must be submitted to TurnItIn™, as required by the TurnItIn™ policy.  A Similarity Index of “blue” or “green” must be obtained.  A score in the blue or green range indicates a similarity of less than 24% which is the benchmark for CCN graduate nursing students.  Any other level of similarity index level requires the student to revise the assignment before the due date and time.  To allow sufficient time for revision, early submission of the assignment to TurnItIn™ is highly encouraged.  The final submission will be graded by faculty.  If a Turnitin™ report indicates that plagiarism has occurred, the Academic Integrity policy will be followed.

3.              A minimum of 4 (four) scholarly references must be used.  A dictionary, required textbooks for this course, and Chamberlain College of Nursing lesson information may NOT be used as scholarly references for this assignment.  References are current – within a 5-year time frame unless a valid rationale is provided and the instructor has approved them.  For additional information regarding scholarly resources, please see “What is a scholarly source?” located in the Course Resource tab.  Information from .com websites may be incorrect.

4.              Title page, running head, body of paper, and reference page must follow APA guidelines as found in the 6th edition of the manual. This includes the use of headings for each section of the paper except for the introduction where no heading is used.

5.              The paper (excluding the title page and reference page) should be at least 5, but no more than 7 pages. Points will be lost for not meeting these length requirements.

6.              Ideas and information that come from scholarly sources must be cited and referenced correctly.

7.              Rules of grammar, spelling, word usage, and punctuation are followed and consistent with formal, scientific writing.

8.              PLEASE note:  Do not rely on .com sites to identify the nursing theory as they do not provide accurate information in all cases.

Preparing the Assignment

Criteria for Format and Special Instructions

9.              This assignment must be submitted to TurnItIn™, as required by the TurnItIn™ policy.  A Similarity Index of “blue” or “green” must be obtained.  A score in the blue or green range indicates a similarity of less than 24% which is the benchmark for CCN graduate nursing students.  Any other level of similarity index level requires the student to revise the assignment before the due date and time.  To allow sufficient time for revision, early submission of the assignment to TurnItIn™ is highly encouraged.  The final submission will be graded by faculty.  If a Turnitin™ report indicates that plagiarism has occurred, the Academic Integrity policy will be followed.

10.           A minimum of 4 (four) scholarly references must be used.  A dictionary, required textbooks for this course, and Chamberlain College of Nursing lesson information may NOT be used as scholarly references for this assignment.  References are current – within a 5-year time frame unless a valid rationale is provided and the instructor has approved them.

11.           Title page, running head, body of paper, and reference page must follow APA guidelines as found in the 6th edition of the manual. This includes the use of headings for each section of the paper except for the introduction where no heading is used.

12.           The paper (excluding the title page and reference page) should be at least 5, but no more than 7 pages. Points will be lost for not meeting these length requirements.

13.           Ideas and information that come from scholarly sources must be cited and referenced correctly.

14.           Rules of grammar, spelling, word usage, and punctuation are followed and consistent with formal, scientific writing.

15.           PLEASE note:  Do not rely on .com sites to identify the nursing theory as they do not provide accurate information in all cases.

Write a 2– to 3–page paper, not including the cover and Reference page, describing:

nursing leadership

  • Reflect on your personal current sense of power within your organization and the profession;
  • Do a self–assessment of your leadership skills by doing the How Good are your Leadership Skills? assessment at http://www.mindtools.com/pages/article/newLDR_50.htm
    • How did you score? You do need not to reveal this in your paper, but hopefully it will guide you in how to apply the concepts to your own situation.
  • Reflect on your motivation for increasing your power within your organization and/or within the nursing profession.
  • Do a self–assessment of your leadership motivation by doing the assessment The Leadership Motivation Assessment found at http://www.mindtools.com/pages/article/newLDR_01.htm
    • Again, it is not necessary to post your score but hopefully it will guide you in how to discuss your motivation at this point in time.
  • Review the information on power in the Learning Resources and conduct additional research on your own to examine strategies that seem relevant and worthwhile for helping to enrich your power as a nurse leader.
  • Identify specific strategies you can use to develop and leverage sources and types of power to achieve desired outcomes.

To Complete

Write a 2– to 3–page paper, not including the cover and Reference page, describing:

  • A self–assessment of your current sense of power within your organization and the profession;
  • A self–assessment of your motivation for increasing your power base;
  • Write a detailed plan for enhancing your power as a nurse and a leader–manager, including specific strategies for achieving that plan.  Be sure to include strategies for mobilizing the power of nursing for social change, empowering others, and building a personal power base.